Pre-eclampsia: pathophysiology, diagnosis, and management

The incidence of pre-eclampsia ranges from 3% to 7% for nulliparas and 1% to 3% for multiparas. Pre-eclampsia is a major cause of maternal mortality and morbidity, preterm birth, perinatal death, and intrauterine growth restriction. Unfortunately, the pathophysiology of this multisystem disorder, characterized by abnormal vascular response to placentation, is still unclear. Despite great polymorphism of the disease, the criteria for pre-eclampsia have not changed over the past decade (systolic blood pressure >140 mmHg or diastolic blood pressure ≥90 mmHg and 24-hour proteinuria ≥0.3 g). Clinical features and laboratory abnormalities define and determine the severity of pre-eclampsia. Delivery is the only curative treatment for pre-eclampsia. Multidisciplinary management, involving an obstetrician, anesthetist, and pediatrician, is carried out with consideration of the maternal risks due to continued pregnancy and the fetal risks associated with induced preterm delivery. Screening women at high risk and preventing recurrences are key issues in the management of pre-eclampsia

La grossesse et l'accouchement chez la femme de plus de 40 ans, en fonction de la parité (étude sur 322 cas à l'hôpital Foch de Suresnes)

Les grossesses tardives sont devenues un sujet de préoccupation dans les pays occidentaux du fait de leur constante augmentation depuis plus de 20 ans, de leur réputation à haut risque et de leur proportion de primipares croissante (20% environ). Pour évaluer les risques que pouvait engendrer l âge maternel >= à 40 ans sur la grossesse, l accouchement et le nouveau-né, nous avons étudié les dossiers des 322 femmes ayant accouché après 40 ans, en les comparant à ceux des 7143 femmes de moins de 40 ans, entre 2004 et 2006 à la maternité de l hôpital Foch. Nous avons observé une augmentation significative mais faible de diabète gestationnel, d hypertension artérielle gravidique, de prééclampsie, et une augmentation plus nette de césarienne, sans explication médicale évidente. Ces césariennes arbitraires sont le reflet de l appréhension des médecins et des patientes face aux grossesses tardives, et remettent en cause le principe de précaution du fait du risque chirurgical pour la mère.ST QUENTIN EN YVELINES-BU (782972101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Iron and Oxidative Stress in Gestational Diabetes

International audienc

Endometriosis and adenomyosis in the crosshair: variants of one disorder or fortuitous coincidence

International audienceAdenomyosis and endometriosis share a common origin as both of them result from the development of endometrial tissue outside the endometrium. Despite this, the 2 disorders were until recently considered as 2 different entities notably, because of their different epidemiology. Today, however, new findings regarding core similarities in pathophysiology and endometrial receptivity – not altered in assisted reproductive technology when using frozen embryo transfers – tend to reunite these 2 ailments as variants of 1 disorder

Endometriosis in transgender men: recognizing the missing pieces

International audienceEndometriosis, traditionally associated with cisgender women, should be recognized as a significant issue for transgender men. This perspective highlights the need to address the unique experiences and challenges faced by transgender men with endometriosis. Diagnostic difficulties arise due to hormone therapy and surgical interventions, which can alter symptoms. Limited research in transgender men undergoing hysterectomy further complicates the understanding of endometriosis in this population. Healthcare providers must be aware of these challenges and adapt the diagnostic approaches accordingly. Education and inclusive care are essential to ensure timely and appropriate management of endometriosis in transgender men, ultimately improving their quality of life. Copyrigh

Epigenetic alterations of the first trimester placenta: insight into preoccupying concerns in assisted reproductive technology

International audienc

General infertility workup in times of high assisted reproductive technology efficacy

International audienceThe assessments of oocyte quality and quantity and endocrine profile have traditionally been the cornerstone of the general workup of couples with infertility. Over the years, several clinical, hormonal, and functional biomarkers have been adopted to assess ovarian function and identify endocrine disorders before assisted reproductive technology. Furthermore, the genetic workup of patients has drastically changed, introducing novel markers. This not only allowed the prediction of response to ovarian stimulation but also contributed toward the development of a safer and more efficient management of women undergoing assisted reproductive technology. The scope of this review is to provide an overview of the current and novel strategies adopted for the assessment of ovarian function and ovulatory and endocrine disorders in women planning to conceive. Furthermore, it aims to provide an insight in the role of novel genetic biomarkers and use of expanded carrier screening as part of preliminary workup of women with infertility

Implantation Failures and Miscarriages in Frozen Embryo Transfers Timed in Hormone Replacement Cycles (HRT): A Narrative Review

The recent advent of embryo vitrification and its remarkable efficacy has focused interest on the quality of hormone administration for priming frozen embryo transfers (FETs). Products available for progesterone administration have only been tested in fresh assisted reproduction technologies (ARTs) and not in FET. Recently, there have been numerous concordant reports pointing at the inefficacy of vaginal preparations at delivering sufficient progesterone levels in a sizable fraction of FET patients. The options available for coping with these shortcomings of vaginal progesterone include (i) rescue options with the addition of injectable subcutaneous (SC) progesterone at the dose of 25 mg/day administered either solely to women whose circulating progesterone is <10 ng/mL or to all in a combo option and (ii) the exclusive administration of SC progesterone at the dose of 25 mg BID. The wider use of segmented ART accompanied with FET forces hormone replacement regimens used for priming endometrial receptivity to be adjusted in order to optimize ART outcomes

Recurrent Implantation Failure—Is It the Egg or the Chicken?

International audienceRecurrent implantation failure (RIF) is an undefined, quite often, clinical phenomenon that can result from the repeated failure of embryo transfers to obtain a viable pregnancy. Careful clinical evaluation prior to assisted reproduction can uncover various treatable causes, including endocrine dysfunction, fibroid(s), polyp(s), adhesions, uterine malformations. Despite the fact that it is often encountered and has a critical role in Assisted Reproductive Technique (ART) and human reproduction, RIF’s do not yet have an agreed-on definition, and its etiologic factors have not been entirely determined. ART is a complex treatment with a variable percentage of success among patients and care providers. ART depends on several factors that are not always known and probably not always the same. When confronted with repeated ART failure, medical care providers should try to determine whether the cause is an embryo or endometrium related. One of the most common causes of pregnancy failure is aneuploidy. Therefore, it is likely that this represents a common cause of RIF. Other RIF potential causes include immune and endometrial factors; however, with a very poorly defined role. Recent data indicate that the possible endometrial causes of RIF are very rare, thereby throwing into doubt all endometrial receptivity assays. All recent reports indicate that the true origin of RIF is probably due to the “egg”

Implantation rates of euploid embryos are not influenced by the duration of estradiol priming, but the hormonal environment—estradiol and progesterone—may affect placentation

International audienc